S1079 Effectiveness of Electronic Medical Record Best Practice Alert for Birth Cohort HCV Screening in an Urban Academic Primary Care Clinic

Abstract

INTRODUCTION: With the advent of direct-acting antiviral therapies in the treatment of chronic hepatitis C virus (HCV) infection, it is possible to cure HCV safely and effectively with high rates of sustained virologic response. However, barriers to eradicating HCV include challenges in screening, diagnosis, and access to care and treatment. This study aims to assess the effectiveness of an automated reminder system embedded within an electronic medical record (EMR) to promote appropriate HCV screening, diagnosis, linkage to care, and treatment within an urban primary care clinic at an academic center. METHODS: This study retrospectively analyzed outcomes after roll out of an automated HCV best practice alert (BPA) that reminded providers to perform guideline-based HCV screening in identified patients. The EMR was queried for HCV BPAs generated between October 2014 and February 2020 during patient encounters at an urban academic primary care clinic. We assessed the number of unique patient charts and queried for patients who received screening, tests with abnormal results, HCV-infected patients who had a subsequent encounter in a gastroenterology (GI) or hepatology clinic, and patients who had an HCV treatment regimen (including interferon-based regimens) listed as an active medication during the study period. Timing of each step in care was also assessed for either completion during or after the year the initial BPA was generated. RESULTS: During the study period, 6839 unique patient charts prompted an HCV BPA during a primary care encounter. 4166 patients (60.9%) received screening within the study period. 287 (6.9%) tested patients had abnormal results. Of the patients found to have HCV infection, 177 (61.7%) had a subsequent encounter in a GI or hepatology clinic. Only 63 patients (21.9%) with HCV infection had an HCV treatment regimen listed as an active medication during the study period. The majority of patients did not have screening, subspecialist encounter, or initiation of treatment completed within the same year as the initial BPA. CONCLUSION: Within an urban academic primary care clinic, an EMR-based alert was associated with high rates of HCV testing, but only a minority of patients with positive HCV Ab were successfully linked to care and HCV therapy. While an EMR-based automated reminder system has the potential to improve screening rates for chronic HCV infection, additional systems-based strategies are likely needed to promote timely HCV screening, linkage to care, and treatment.Table 1.: Screening, linkage to care, and treatment for HCV after BPA generated during primary care encounter (N = 6839)